Peter Pronovost is an anesthesiologist and critical-care specialist at Johns Hopkins Hospital. Pronovost had noticed that about forty thousand people in the United States died each year from infections caused by central line catheters— intravenous tubes placed in patients as part of their treatment. These deaths typically showed up as “complications” from surgery, but were completely preventable. Yet the number of people dying from these infections was equal to the number of women dying from breast cancer each year.

Checklists are powerful for straightforward tasks like this — but only if people use them.

How often did doctors use them after Pronovost put them together?

The compliance rate was only 38%.

Thirty-eight percent.

That’s what happens when you ask very smart people to do something that saves lives.

What hope is there for less intelligent people on average tasks?

So how do you implement a checklist so that people actually use it?

2) Make it easy to comply through preparation

Pronovost put all the required elements for the checklist activities in to one accessible place.

He quickly realized that a major part of the problem was that the supplies were scattered in different places, requiring doctors and nurses to gather gloves, masks, drapes, and tubes from various locations. He created a “central line cart” so that everything a doctor would need was readily available in one place. Compliance rose to 70 percent…

But 70% isn’t 100% — and in this case we’re talking about human lives.

What does it take to get people to do things right — all the time?

3) Put someone in charge of compliance

You get lazy. You get overconfident in your abilities. Lists can seem demeaning, like you’re second guessing yourself.

He had no doubt that the doctors wanted to take excellent care of their patients and that they could readily enumerate the items on the checklist if asked. The problem was that the physicians simply didn’t focus on the mundane tasks. So Pronovost took the unusual step of placing the nurses in charge of compliance. Hospitals, like many other organizations, are hierarchical, and doctors are at the top of the heap. But Pronovost sat down with the staff and explained what he was trying to achieve and why it was so important. At first, the doctors saw it as an effort to undermine their authority, while the nurses worried that it would open them up to criticism. But Pronovost convinced all parties to try the new approach. Within a year, the rate of infection dropped nearly to zero.

So what do you do now?

Make a checklist.

Put everything needed to execute it in one place ahead of time.

Make sure you have a reminder — someone or something to bug you.

If it can save lives, it can certainly make a difference in your life.